Ramsay Hunt syndrome complicated by a brainstem lesion

Chung, Pil-Wook; Oh, Se-Mi; Hong, Seung Bong; Chung, Chin‐Sang; Jung, Chul Won; Kim, Sung Tae; Hong, Sang Duk; Seo, Dae-Won

doi:10.1016/j.jcv.2007.05.002

Cited by 26 publications

(22 citation statements)

References 13 publications

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“…VZV involvement of the geniculate ganglion is known as Ramsay Hunt syndrome (RHS), characterized by ipsilateral facial paralysis, otic pain, and herpetic lesions of the external auditory canal and auricle [3]. To the best of our knowledge, there have been 3 prior cases of RHS complicated exclusively by cerebellitis [1,4,5] and 3 prior cases of RHS complicated exclusively by rhombencephalitis [6][7][8]. While isolated involvement of the brainstem, cerebellum, and spinal cord has been discussed in the literature, no reports to our knowledge have described concurrent brainstem and cerebellar involvement [9].…”

Section: Introductionmentioning

confidence: 99%

Brainstem and Cerebellar Involvement in Ramsay Hunt Syndrome

Letchuman

Donohoe

2019

Case Reports in Otolaryngology

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We present a case of a 62-year-old Caucasian male with laryngeal cancer and Ramsay Hunt Syndrome otherwise known as herpes zoster oticus due to reactivation of the varicella zoster virus. Classic findings include the triad of ipsilateral facial paralysis, otic pain, and herpetic lesions in the sensory supply of the facial nerve. e common pathogenesis is associated with anterograde axonal reactivation of the varicella zoster virus in the geniculate ganglion. Unique features of our case include retrograde transaxonal spread of the varicella-zoster virus from the geniculate ganglion into the brainstem and cerebellum including involvement of the abducens nucleus, facial nucleus, middle cerebral peduncle, and inferior cerebellar peduncle. is presented as left facial paralysis, left sixth nerve palsy, horizontal diplopia to the left lateral gaze, profound truncal ataxia, and left-sided dysmetria. Clinical awareness that Ramsay Hunt syndrome may also involve the brainstem and cerebellum is critical in evaluating the clinical neurologic findings and expanding the diagnostic workup to include brain magnetic resonance imaging and cerebrospinal fluid analysis, including varicella zoster polymerase chain reaction. Encephalitis requires longer duration administration of high-dose intravenous acyclovir in conjunction with steroids. Delays in treatment are often associated with unsatisfactory outcomes with extensive residual deficits.

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Section: Introductionmentioning

confidence: 99%

Brainstem and Cerebellar Involvement in Ramsay Hunt Syndrome

Letchuman

Donohoe

2019

Case Reports in Otolaryngology

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“…The vestibulocochlear nerve (eighth cranial nerve) and the facial nerve involvement complete the classical triad of the RamsayeHunt syndrome; herpes zoster of external ear or tympanic membrane, ipsilateral facial paralysis and auditory symptoms. 32,33 Compression of the vestibulocochlear nerve may cause auditory symptoms which are sensorineural hearing loss, tinnitus, dizziness and vertigo. Involvement of the nervus intermedius or its geniculate ganglion would impair taste sensation from the anterior two-thirds of the tongue and alter lacrimation.…”

Section: Oral Manifestationsmentioning

confidence: 99%

Herpes zoster with oro-facial involvement – Report of a case and detailed review of literature

Hasan

Khan

Nakeb

et al. 2012

Indian Journal of Dentistry

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Herpes zoster or shingles is a recurrence of varicella zoster virus that entered the cutaneous nerve endings during an earlier episode of chicken pox, travelled to the dorsal root ganglia, and remained in a latent form. Nerves most commonly involved are C3, T5, L1, L2 and first division of trigeminal nerve. The condition is characterized by occurrence of multiple, painful, unilateral vesicles and ulceration which shows a typical single dermatome involvement. The infection usually affects elderly individuals, and if present in the younger age group, a suspicion should be raised about the immune-compromised status such as HIV. Many patients report to the dental clinic with the complications of herpes zoster, with trigeminal nerve involved in about 15% cases and most commonly the ophthalmic division. Diagnosing these complications of herpes zoster could pose a challenge to an oral physician due to their varied presentation ranging from post herpetic neuralgia, external root resorption, osteonecrosis and tooth exfoliation. This paper reports a case of herpes zoster with unilateral vesicles over the left side of upper and middle 1/3rd of face along the trigeminal nerve tract, with intraoral involvement of buccal mucosa and palate on the same side.

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“…Dear Editor, Varicella-zoster virus (VZV) is a DNA virus transmitted via droplets. It lies latent in neurons and causes zona zoster, central nervous system infections or Ramsey Hunt syndrome (RHS) by reactivation (1). Classic RHS is characterized by herpes zoster oticus and unilateral facial paralysis (2,3,4).…”

mentioning

confidence: 99%

“…Rarely, V., VI., IX., X., XI. and XII th cranial nerve palsies have been reported in the literature (1).…”

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confidence: 99%